노인두통의 임상적 접근

Clinical Approach to Headaches in the Elderly

Headaches in the elderly, although less prevalent than in younger adults, is a common complaint that presents a special challenge to the physician. Headaches in the elderly can conveniently be divided into primary and secondary headaches. Primary headache disorders, such as migraine, cluster headache, and tension-type headache, are diseases unto themselves. Secondary headache represents a symptom of an underlying disease such as an intracranial mass lesion or a metabolic disorder. The clinician faces not only a broad differential diagnosis, but must contend with the difficulty of managing headache when comorbid illnesses can contraindicate or complicate effective treatments. Although the overall incidence of headache declines with advancing age, the relative proportion of secondary headaches increase, thus highlighting the importance of a careful evaluation and a high level of suspicion when evaluating an elderly patient with a complaint of headache.